PTSD linked to urinary tract symptoms in Iraq and Afghanistan war veterans

NEW YORK (Reuters Health) – Along with the psychological troubles afflicting military veterans of Iraq and Afghanistan with posttraumatic stress disorder (PTSD) comes a higher risk for a physical problem, namely, lower urinary tract symptoms (LUTS), a new study shows.

Findings from the retrospective study were discussed this week in Atlanta at the 107th Annual Scientific Meeting of the American Urological Association (AUA).

“PTSD appears to be an independent risk factor for having urinary complaints and doctors should screen for LUTS in a patient who may have PTSD,” Dr. Benjamin Breyer, from the University of California, San Francisco told Reuters Health.

“The study didn’t get at the exact pathophysiology but there are hypotheses that have been suggested,” he said. “There is an association between depression, anxiety, and lower urinary tract symptoms that has been demonstrated in other populations and the thought is maybe it is related to the autonomic nervous system, maybe it’s related to neurotransmitters, such as serotonin.”

He continued, “These patients are on a lot of different medications including psychotropic medications to treat their PTSD, and these medications influence lower urinary tract symptoms.”

Dr. Breyer and his group analyzed data from the Department of Veteran Affairs (VA) administrative database of 643,599 Iraq and Afghanistan war veterans enrolled in VA healthcare after military service separation between 2001 and 2011. The median age of the veterans was 26 years.

The researchers identified PTSD and LUTS from ICD-9 diagnostic codes. The prevalence of PTSD during the study period was 28.5%, and the prevalence of LUTS was 1.6%.

Compared with male veterans without PTSD, those with PTSD were more likely to suffer from LUTS (2.9% vs 1.1%, p<0.001).

Veterans with PTSD were also more likely to receive prescriptions for an alpha blocker or a 5 alpha-reductase inhibitor (1.7% vs 0.7%, p<0.001) and to have attended a urology clinic (8.1% vs 3.6%, p<0.001).

After adjusting for sociodemographic, military service characteristics, and spinal cord injury, the study found that PTSD independently increased the relative risk of LUTS by nearly 3 times (adjusted relative risk = 2.81).

The relative risk decreased after further adjustment for medications used to treat PTSD, such as selective serotonin reuptake inhibitors and other psychoactive drugs, as well as urology clinic visit history, but LUTS still remained significantly associated with PTSD (aRR = 1.19).

Commenting on this study for Reuters Health, Dr. Christopher Amling, from the Oregon Health and Sciences University in Portland, who is a spokesperson for the AUA, said the study is important because it suggests that military service can impact urinary function, something that was previously not known.

“I don’t know that there’s much in the literature to suggest that, so this is new information. We need to devote some time, effort and research to try to figure out what the causes might be so that it can be prevented,” he said.